Strength,power output and symmetry of leg muscles: effect of age and history of falling

Risk factors for medically unexplained falls may include reduced muscle power, strength and asymmetry in the lower limbs. Conflicting reports exist about strength and there is little information about power and symmetry. Forty-four healthy young people (29.3 ± 0.6 years), 44 older non-fallers (75.9 ± 0.6 years), and 34 older fallers (76.4 ± 0.8 years) were studied. Isometric, concentric and eccentric strength of the knee and ankle muscles and leg extension power were measured bilaterally. The younger group was stronger in all muscles and types of contraction than both older groups (P < 0.02–0.0001). Strength differences between the older groups occasionally reached significance in individual muscles and types of contraction but overall the fallers had 85% of the strength and 79% of the power of the non-fallers (P < 0.001). Young subjects generated more power than both older groups (P < 0.0001) and the fallers generated less than the non-fallers (P = 0.03). Strength symmetry showed an inconsistent age effect in some muscles and some contraction types. This was similar overall in the two older groups. Both older groups had greater asymmetry in power than the young (P < 0.02–0.004). Power asymmetry tended to be greater in the fallers than the non-fallers but this did not reach significance. These data do not support the suggestion that asymmetry of strength and power are associated with either increasing age or fall history. Power output showed clear differences between age groups and fall status and appears to be the most relevant measurement of fall risk and highlights the cumulative effects on function of small changes in strength in individual muscle groups.     

Older adults use a unique strategy to lift inertial loads with the elbow flexor muscles

The purpose of this study was to determine the effect of age on the ability to exert steady forces and to perform steady flexion movements with the muscles that cross the elbow joint. An isometric task required subjects to exert a steady force to match a target force that was displayed on a monitor. An anisometric task required subjects to raise and lower inertial loads so that the angular displacement around the elbow joint matched a template displayed on a monitor. Steadiness was measured as the coefficient of variation of force and as the normalized standard deviation of wrist acceleration. For the isometric task, steadiness as a function of target force decreased similarly for old adults and young adults. For the anisometric task, steadiness increased as a function of the inertial load and there were significant differences caused by age. Old adults were less steady than young adults during both shortening and lengthening contractions with the lightest loads. Furthermore, old adults were least steady when performing lengthening contractions. These behaviors appear to be associated with the patterns of muscle activation. These results suggest that different neural strategies are used to control isometric and anisometric contractions performed with the elbow flexor muscles and that these strategies do not change in parallel with advancing age.     

Stepping impairment and falls in older adults: A systematic review and meta-analysis of volitional and reactive step tests

ObjectiveTo systematically examine stepping performance as a risk factor for falls. More specifically, we examined (i) if step tests can distinguish fallers from non-fallers and (ii) the type of step test (e.g. volitional vs reactive stepping) that is required to distinguish fallers from non-fallers.Data sourcePubMed, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and reference lists of included articles.Study selection: Cross-sectional and cohort studies that assessed the association between at least one step test and falls in older people (age ≥ 60 and/or mean age of 65).ResultsA meta-analysis of 61 studies (n = 9536) showed stepping performance was significantly worse in fallers compared to non-fallers (Cohen’sd 0.56, 95 % CI 0.48 to 0.64, p < 0.001, I² 66 %). This was the case for both volitional and reactive step tests. Twenty-three studies (n = 3615) were included in a diagnostic meta-analysis that showed that step tests have moderate sensitivity (0.70, 95 % CI 0.62 to 0.77), specificity (0.68, 95 % CI 0.58 to 0.77) and area under the receiver operating characteristics curve (AUC) (0.75, 95 % CI 0.59 to 0.86) in discriminating fallers from non-fallers.Conclusions: This large systematic review demonstrated that both volitional and reactive stepping impairments are significant fall risk factors among older adults. Step tests can identify fallers from non-fallers with moderate accuracy.     

Sex differences in force steadiness in three positions of the forearm

The purpose of this study was to examine force steadiness in three positions of the forearm in young men and women across a variety of force levels. Eight young men and eight young women performed three maximum voluntary contractions (MVCs) in the neutral, supinated, and pronated forearm positions. Viewing a target line on a computer screen, subjects performed submaximal isometric contractions relative to their own MVC at 2.5, 5, 10, 25, 50, and 75% in each of the three forearm positions. Force steadiness was determined as the coefficient of variation (standard deviation around the mean force). A repeated-measures three-way ANOVA was used to assess the differences in force steadiness between sex, position, and force level. Men were stronger than women in all three forearm positions. Overall, men were steadier than women across all force levels and forearm positions. The neutral and supinated positions were equally strong and steady, and the pronated position was the weakest and least steady position. The forearm was most steady between 25 and 75% MVC, and least steady at the lower force levels. When correlations were run between MVC and coefficient of variation at all force levels and all forearm positions, a strong negative relationship was found (r = ?0.49). In conclusion, men were stronger, as well as steadier, than women. The neutral and supinated forearm positions were both stronger and steadier than the pronated position. Results suggest that one of the primary factors influencing sex differences in force steadiness is absolute strength.     

Power output, isometric strength and steadiness in the leg muscles of pre- and postmenopausal women; the effects of hormone replacement therapy

There are conflicting reports of the effects of hormone replacement therapy (HRT) on strength preservation in postmenopausal women, while any effect on power output has received little attention. Decreased steadiness of force generation has been reported in older muscles and may be related to the hormonal changes associated with the menopause, but the effect of HRT has not been investigated. We have studied the effect of HRT on strength, power output and isometric force steadiness in healthy women. Sixteen young (aged 27.4±1.4 years, mean ± SEM) and 29 postmenopausal women were studied. Fifteen of the latter were taking HRT (68.1±1.4 years, HRT+) and 14 (70.5±1.5 years, HRT−) had never done so. During isometric quadriceps contractions the force steadiness (coefficient of variation of force) was measured at 10, 25, 50 and 100% maximum voluntary contraction (MVC). The average power generated by an explosive leg extension was recorded. The HRT− group generated less power (110.2±7.2 W) than both the HRT+ (136.5±10.9 W, P=0.027) and young (136.2±5.8 W, P=0.027) subjects. Power output was similar in the HRT+ and younger subjects. The HRT− subjects were weaker than the younger ones (241.3±14.0 N vs. 297.6±13 N, P=0.006). The strength of the HRT+ group (255.5±14 N) was not significantly different to the other two groups. There was no difference in steadiness between the three groups at any of the force levels. HRT appears to maintain power output to a greater extent than isometric strength in postmenopausal women. There was no evidence for an effect of either age or HRT on isometric steadiness in the quadriceps.     

Eccentric exercise and delayed onset muscle soreness of the quadriceps induce adjustments in agonist–antagonist activity,which are dependent on the motor task

This study investigates the effects of eccentric exercise and delayed onset muscle soreness (DOMS) of the quadriceps on agonist–antagonist activity during a range of motor tasks. Ten healthy volunteers (age, mean ± SD, 24.9 ± 3.2 years) performed maximum voluntary contractions (MVC) and explosive isometric contractions of the knee extensors followed by isometric contractions at 2.5, 5, 10, 15, 20, and 30% MVC at baseline, immediately after and 24 h after eccentric exercise of the quadriceps. During each task, force of the knee extensors and surface EMG of the vasti and hamstrings muscles were recorded concurrently. Rate of force development (RFD) was computed from the explosive isometric contraction, and the coefficient of variation of the force (CoV) signal was estimated from the submaximal contractions. Twenty-four hours after exercise, the subjects rated their perceived pain intensity as 4.1 ± 1.2 (score out of 10). The maximum RFD and MVC of the knee extensors was reduced immediately post- and 24 h after eccentric exercise compared to baseline (average across both time points: 19.1 ± 17.1% and 11.9 ± 9.8% lower, respectively, P < 0.05). The CoV for force during the submaximal contractions was greater immediately after eccentric exercise (up to 66% higher than baseline, P < 0.001) and remained higher 24 h post-exercise during the presence of DOMS (P < 0.01). For the explosive and MVC tasks, the EMG amplitude of the vasti muscles decreased immediately after exercise and was accompanied by increased antagonist EMG for the explosive contraction only. On the contrary, reduced force steadiness was accompanied by a general increase in EMG amplitude of the vasti muscles and was accompanied by increased antagonist activity, but only at higher force levels (>15% MVC). This study shows that eccentric exercise and subsequent DOMS of the quadriceps reduce the maximal force, rate of force development and force steadiness of the knee extensors, and is accompanied by different adjustments of agonist and antagonist muscle activities.     

Motor-unit synchronization is not responsible for larger motor-unit forces in old adults

Motor-unit synchronization, which is a measure of the near simultaneous discharge of action potentials by motor units, has the potential to influence spike-triggered average force and the steadiness of a low-force isometric contraction. The purpose of the study was to estimate the contribution of motor-unit synchronization to the larger spike-triggered average forces and the decreased steadiness exhibited by old adults. Eleven young (age 19-30 yr) and 14 old (age 63-81 yr) adults participated in the study. Motor-unit activity was recorded with two fine-wire intramuscular electrodes in the first dorsal interosseus muscle during isometric contractions that caused the index finger to exert an abduction force. In a separate session, steadiness measurements were obtained during constant-force isometric contractions at target forces of 2.5, 5, 7. 5, and 10% of the maximum voluntary contraction (MVC) force. Mean (+/-SD) motor-unit forces measured by spike-triggered averaging were larger in old (15.5 +/- 12.1 mN) compared with young (7.3 +/- 5.7 mN) adults, and the differences were more pronounced between young (8.7 +/- 6.4 mN) and old (19.9 +/- 12.2 mN) men. Furthermore, the old adults had a reduced ability to maintain a steady force during an isometric contraction, particularly at low target forces (2.5 and 5% MVC). Mean (+/-SD) motor-unit synchronization, expressed as the frequency of extra synchronous discharges above chance in the cross-correlogram, was similar in young [0.66 +/- 0.4 impulses/s (imp/s); range, 0.35-1.51 imp/s; 53 pairs) and old adults (0.72 +/- 0.5 imp/s; range, 0.27-1.38 imp/s; 56 pairs). The duration of synchronous peaks in the cross-correlogram was similar for each group (approximately 16 ms). These data suggest that motor-unit synchronization is not responsible for larger spike-triggered average forces in old adults and that motor-unit synchronization does not contribute to the decreased steadiness of low-force isometric contractions observed in old adults.     

Resistance and functional training reduces knee extensor position fluctuations in functionally limited older adults

The purpose of this study was to determine the effect of task-specificity on knee extensor steadiness adaptations in functionally limited older adults. Twenty-four functionally limited older adults (74.6±7.6 years: 22 women, 2 men) completed a 10-week control period followed by 10 weeks (2 days/week) of resistance (RT), functional (FT) (practicing everyday tasks, i.e., chair rises) or functional + resistance (FRT) training, which featured both shortening and lengthening movements. During testing, subjects performed a steady isometric [10, 25, 50% of maximal voluntary contraction (MVC)] and shortening/lengthening (5, 30, 65% of MVC) knee extensor contractions. There were no steadiness (isometric, shortening or lengthening contractions) changes in the control period and no adaptations in isometric steadiness due to training. RT induced a 37% reduction in shortening fluctuations at 5% of MVC and 35% reduction in lengthening fluctuations at both 30% and 65% of MVC. FRT induced a 60% reduction in shortening fluctuations at 30% of MVC. No adaptations in dynamic steadiness were observed in the FT group. Further analysis indicated that those who were the least steady at baseline showed the greatest training effects during isometric (RT: R ²=0.25, FRT: R ²=0.49, FT: R ²=0.38), shortening (RT: R ²=0.36, FRT: R ²=0.36, FT: R ²=0.35) and lengthening (RT: r ²=0.29, FRT: r ²=0.44) contractions. In conclusion, steadiness improvements in groups performing resistance exercise, without a concomitant improvement in the FT group, supports a role for task-specificity in explaining steadiness adaptations, particularly for unsteady older adults.     

Effect of prolonged unweighting of human skeletal muscle on neuromotor force control

The purpose of this study was to determine the effect of 4 weeks of unilateral lower limb suspension (ULLS) on the fluctuations in motor output and the associated physiological changes. Subjects (n = 17) performed steady isometric plantarflexion (PF) and knee extension (KE) tasks, and KE shortening and lengthening contractions (intensity = 25% maximum). Spinal excitability of the soleus muscle was assessed via the H-reflex, muscle cross-sectional area (CSA) via MRI, along with EMG activity during the PF tasks. Following ULLS, isometric force fluctuations increased ∼12% for the PF, and 22% for the KE (P < 0.05), with no difference in the pattern of PF muscle activation (P = 0.46). The unsteadiness of lengthening KE contractions increased 25% following ULLS (P = 0.03), while KE steadiness during shortening contractions was not altered (P = 0.98). Significant correlations were observed between the percent changes in PF isometric force fluctuations and H-reflex (r = 0.49, P = 0.04), and between the PF isometric force fluctuations and PF CSA (r = −0.61, P < 0.01). These findings suggest the effects of unweighting on neuromotor performance are muscle group and contraction type dependent, and that the disuse-paradigm altering muscle CSA and spinal excitability may serve to mediate the associated loss of steadiness. Data for this project were collected in the Musculoskeletal Research Laboratory at Syracuse University.     

Effects of experimental muscle pain on shoulder-abduction force steadiness and muscle activity in healthy subjects

We previously demonstrated that the steadiness of shoulder abduction is reduced in patients with subacromial impingement syndrome (SIS), which might be related to shoulder pain associated with the SIS. The aim of the present study was to examine the acute effects of experimental shoulder muscle pain on shoulder motor function in healthy subjects. The fluctuations in exerted force (force steadiness) and electromyographic (EMG) activity from eight shoulder muscles were determined during sub-maximal isometric and dynamic contractions with the shoulder abductors in nine healthy subjects (27.7 ± 4.2 years, mean ± 1 SD) before, during and after experimental pain induction. Experimental pain was induced by bolus injections of 6% hypertonic saline into the supraspinatus muscle. Experimental muscle pain reduced shoulder-abduction force steadiness on average by 21% during isometric contractions (P = 0.012) and tended to do so during concentric contractions (P = 0.083). Middle deltoid, and infraspinatus and lower trapezius muscle activity increased (3–5% EMG_max) during isometric and concentric contractions, respectively (P < 0.05). Thus, experimental shoulder muscle pain reduced the steadiness of isometric shoulder abduction and caused small changes in the abduction activation strategy. The observed effects of experimental pain on shoulder motor function differed from that observed previously in patients with SIS and chronic pain during the same types of contractions. A possible explanation may be that, even though the adopted experimental pain-paradigm may reflect the SIS in terms of the painful structures, it might not reflect the adaptations in the central nervous system seen with chronic pain.